A comprehensive approach to premenstrual complaints

Abstract

Background: General practice is characterised by its person-centred approach. It crosses the boundaries of all the medical disciplines as well as the boundary between medical and social problems. Family physicians are committed to dealing with whatever problem the patient presents. This is particularly relevant when women present with premenstrual complaints, since most do not have PMS as defined by researchers. Many have problems external to the menstrual cycle contributing to symptoms. Detection of these external factors, be they intercurrent medical, psychiatric or social problems, frequently determines treatment.

Objective: To describe a simple model of premenstrual complaints which includes all women who present in this way, in order ot inform GPs of the common patterns of illness in this group and provide them with a systematic approach to management.

Discussion: The model contains up to four levels of activity which may contribute to the complaint. These are: 1. menstrual cycle physiology--resulting in cyclical changes in mood, breast and bloating 2. intercurrent pathology (comorbidity)--gynaecological, psychiatric and medical 3. the social context of marital, family and work relationships, cultural influences 4. interpretation (attribution)--the meaning attached to the experience of the first 3 factors.